Opening and closing wedge osteotomy guide and method

ABSTRACT

Methods and devices for performing an osteotomy on a bone are presented. In one example of the invention, a method of performing an osteotomy on a bone includes removing a portion of bone from a first side of the bone to create a gap on the first side of the bone; making a cut on a second side of the bone, opposite the first side; and rotating the bone from a first position to a second position to close the gap on the first side of the bone and open the cut on the second side of the bone to create a gap on the second side of the bone.

CROSS REFERENCE TO RELATED PATENT APPLICATION

This application is a continuation of U.S. patent application Ser. No.17/157,146, filed Jan. 25, 2021, which is a continuation of U.S. patentapplication Ser. No. 14/994,362, filed Jan. 13, 2016, both titledOPENING AND CLOSING WEDGE OSTEOTOMY GUIDE AND METHOD, which claims thebenefit of U.S. Provisional Application No. 62/103,397, filed Jan. 14,2015, titled OSTEOTOMY GUIDE AND METHOD, all of which are incorporatedherein by reference in their entirety.

FIELD OF THE INVENTION

The invention relates to methods, implants, and instruments forperforming an osteotomy on a bone.

BACKGROUND

Various conditions may affect skeletal joints such as the deterioration,elongation, shortening, or rupture of soft tissues, cartilage, and/orbone associated with the joint and consequent laxity, pain, and/ordeformity. It is often desirable to change the angular alignment of abone or a portion of a bone to restore function and/or reduce pain. Tothis end, various osteotomy procedures and instruments have beenproposed. For example, osteotomies have been performed throughout thebody to make various angular adjustments such as in a tibia, fibula,femur, pelvis, humerus, ulna, radius, metacarpal, metatarsal, and otherbones. Prior osteotomies couple angular correction and change in bonelength in ways that often produce undesirable results.

SUMMARY

The present invention provides methods, implants, and instruments forperforming an osteotomy on a bone.

In one example of the invention, a method of performing an osteotomy ona bone includes removing a portion of bone from a first side of the boneto create a gap on the first side of the bone; making a cut on a secondside of the bone, opposite the first side; and rotating the bone from afirst position to a second position to close the gap on the first sideof the bone and open the cut on the second side of the bone to create agap on the second side of the bone.

In another example of the invention, a method of performing an osteotomyon a metatarsus of a first ray of the human foot includes positioning anosteotomy guide adjacent the metatarsus; guiding a cutter to remove aportion of bone from a first side of the metatarsus to create a gap onthe first side of the metatarsus; guiding a cutter to make a cut on asecond side of the metatarsus, opposite the first side; rotating themetatarsus from a first position to a second position to close the gapon the first side of the metatarsus and open the cut on the second sideof the metatarsus to create a gap on the second side of the metatarsus;and filling the gap created on the second side of the metatarsus.

In another example of the invention, an osteotomy guide includes a guidebody having a proximal end, a distal end, and first and second sides.The first side includes first and second guide surfaces that convergefrom the first side toward the second side. The first and second guidesurfaces are operable to guide a cutter to remove a wedge of bone from afirst side of a bone. The second side includes a third guide surfaceextending toward but stopping short of the first and second guidesurfaces. The third guide surface being operable to guide a cutter tomake a cut on a second side of a bone.

BRIEF DESCRIPTION OF THE DRAWINGS

Various examples of the present invention will be discussed withreference to the appended drawings. These drawings depict onlyillustrative examples of the invention and are not to be consideredlimiting of its scope.

FIG. 1 is side elevation view of a foot illustrating anatomic referenceplanes and relative directions;

FIG. 2 is a lateral view of a foot illustrating dorsiflexion and plantarflexion;

FIG. 3 is a coronal view of a foot illustrating inversion and eversion;

FIG. 4 is a dorsal view illustrating bones, tendons, and ligaments ofthe foot;

FIG. 5 is a plantar view illustrating bones, tendons, and ligaments ofthe foot;

FIG. 6 is a perspective view illustrating bones, tendons, and ligamentsof the foot;

FIG. 7 is a medial view of the MTP joint of the first ray of the foot;

FIG. 8 is a sectional view taken along line 8-8 of FIG. 7;

FIG. 9 is a dorsal view of the MTC joint of the first ray of the foot;

FIG. 10 is a medial view of the MTC joint of the first ray of the foot;

FIG. 11 is a dorsal view illustrating deformity of the foot;

FIG. 12 is a plantar view illustrating deformity of the foot;

FIG. 13 is a sectional view similar to that of FIG. 8 but illustratingdeformity of the foot;

FIG. 14 is an isometric view of an osteotomy guide according to thepresent invention;

FIG. 15 is a top plan view of the osteotomy guide of FIG. 14;

FIG. 16 is a side elevation view of the osteotomy guide of FIG. 14;

FIG. 17 is a front elevation view of the osteotomy guide of FIG. 14;

FIGS. 18-21 are dorsal views illustrating the use of the osteotomy guideof FIG. 14 to correct a deformity;

FIG. 22 is a medial view of the corrected deformity;

FIG. 23 is an isometric view showing the top of an osteotomy guideaccording to the present invention;

FIG. 24 is a top plan view of the osteotomy guide of FIG. 23;

FIG. 25 is a front elevation view of the osteotomy guide of FIG. 23;

FIG. 26 is a side elevation view of the osteotomy guide of FIG. 23;

FIG. 27 is an isometric view showing the bottom of the osteotomy guideof FIG. 23; and

FIG. 28 is a top plan view showing a set of osteotomy guides like thatof FIG. 23 having various correction angles and configured for left andright corrections.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

The following illustrative examples describe implants, instruments andtechniques for performing an osteotomy on a bone. The present inventionmay be used to perform osteotomies on any bone including but not limitedto a tibia, fibula, femur, pelvis, humerus, ulna, radius, metacarpal,and metatarsal. However, for convenience, the invention will beillustrated with reference to a metatarsal bone of the first ray of ahuman foot.

FIG. 1 illustrates the orientation of anatomic planes and relativedirectional terms that are used for reference in this application. Thecoronal plane 10 extends from medial 12 (toward the midline of the body)to lateral (away from the midline of the body) and from dorsal 14(toward the top of the foot) to plantar 16 (toward the sole of thefoot). The sagittal plane 18 extends from anterior 20 (toward the frontof the body) to posterior 22 (toward the back of the body) and fromdorsal 14 to plantar 16. The transverse plane 24 extends anterior 20 toposterior 22 and medial to lateral parallel to the floor 26. Relativepositions are also described as being proximal or distal where proximalis along the lower extremity toward the knee and distal is along thelower extremity toward the toes. The following examples serve todemonstrate the relative directions. The great toe is medial of thelesser toes and the fifth toe is lateral of the great toe. The toes aredistal to the heel and the ankle is proximal to the toes. The instep isdorsal and the arch is plantar. The toenails are dorsal and distal onthe toes.

FIG. 2 illustrates dorsiflexion 23 in which the toes are moved dorsally,or closer to the shin, by decreasing the angle between the dorsum of thefoot and the leg and plantar flexion 25 in which the toes are movedplantar, or further away from the shin, by increasing the angle betweenthe dorsum of the foot and the leg. For example when one walks on theirheels, the ankle is dorsiflexed and when one walks on their toes, theankle is plantar flexed.

FIG. 3 illustrates inversion 27 in which the sole of the foot is tiltedtoward the sagittal plane or midline of the body and eversion 29 inwhich the sole of the foot is tilted away from the sagittal plane.

FIGS. 4-10 illustrate the arrangement of the bones within the foot 30. Aright foot is illustrated. Beginning at the proximal example of thefoot, the heel bone or calcaneus 32 projects plantar. The talus 34 isdorsal to the calcaneus 32 and articulates with it at the talocalcanealor subtalar joint. Dorsally, the talus articulates medially with thetibia 36 and laterally with the fibula 38 at the ankle joint. Distal tothe ankle are the navicular bone 40 medially and the cuboid bone 42laterally which articulate with the talus and calcaneus respectively.The navicular bone 40 and cuboid bone 42 may also articulate with oneanother at the lateral side of the navicular bone and the medial side ofthe cuboid bone. Three cuneiform bones lie distal to the navicular boneand articulate with the navicular bone and one another. The first, ormedial, cuneiform 44 is located on the medial side of the foot 30. Thesecond, or intermediate, cuneiform 46 is located lateral of the firstcuneiform 44. The third, or lateral, cuneiform 48 is located lateral ofthe second cuneiform 46. The third cuneiform 48 also articulates withthe cuboid bone 42. Five metatarsals 50, 52, 54, 56, 58 extend distallyfrom and articulate with the cuneiform and cuboid bones. The metatarsalsare numbered from I to 5 starting with the first metatarsal 50 on themedial side of the foot and ending with the fifth metatarsal 58 on thelateral side of the foot 30.

The first metatarsal 50 articulates with the first cuneiform 44 at ametatarso cuneiform (MTC) joint 51. The second metatarsal 52 articulateswith the first, second and third cuneiforms 44, 46, 48 and mayarticulate with the first metatarsal as well. Five proximal phalanges60, 62, 64, 66, 68 extend distally from and articulate with the fivemetatarsals respectively. The first proximal phalanx 60 articulates withthe first metatarsal 50 at a metatarsophalangeal (MTP) joint 61. One ormore distal phalanges 70, 72, 74, 76, 78, 80 extend distally from theproximal phalanges. The first metatarsal 50, first proximal phalanx 60,and, first distal phalanx 70 together are referred to as the first rayof the foot. Similarly, the metatarsal, proximal phalanx, and distalphalanges corresponding to the lesser digits are referred to as thesecond through fifth rays respectively.

FIG. 4 is a dorsal view illustrating bones, tendons and ligaments of thefoot. Plantar structures illustrated in FIG. 5 are omitted from FIG. 4for clarity. The extensor hallucis longus muscle originates in theanterior portion of the leg, the extensor hallucis longus tendon 80extends distally across the ankle and along the first ray to insert intothe base of the distal phalanx 70. The tibialis anterior muscleoriginates in the lateral portion of the leg and the tibialis anteriortendon 82 extends distally across the ankle and inserts into the firstcuneiform 44 and first metatarsus 50 at the first MTC joint 51 where itcontributes to the MTC capsular structure 84 (FIGS. 9 and 10). Atransverse intermetatarsal ligament 83 inserts into the capsule of theMTP joint such that it connects the heads of the first through fifthmetatarsal bones. In FIG. 4, only the connection between the first andsecond metatarsal bones 50, 52 is shown.

FIG. 5 is a plantar view illustrating bones, tendons, and ligaments ofthe foot. Dorsal structures shown in FIG. 4 are omitted from FIG. 5 forclarity. The peroneus longus muscle originates at the head of the fibulaand its tendon 86 passes posteriorly around the lateral malleolus 88 ofthe ankle, around the cuboid notch 90 on the lateral side of the cuboidbone 42, along the peroneal sulcus 92 on the plantar surface of thecuboid bone 42, and inserts into the first metatarsal 50. The flexorhallucis brevis muscle 94 originates from the cuboid 42 and thirdcuneiform 48 and divides distally where it inserts into the base of theproximal phalanx 60.

Medial and lateral sesamoid bones 96, 98 are present in each portion ofthe divided tendon at the MTP joint 61. The sesamoids 96, 98 articulatewith the planar surface of the metatarsal head in two grooves 100, 102separated by a rounded ridge, or crista 104 (FIG. 8). The flexorhallucis longus muscle originates from the posterior portion of thefibula 38. The flexor hallucis longus tendon 106 crosses the posteriorsurface of the lower end of the tibia, the posterior surface of thetalus, runs forward between the two heads of the flexor hallucis brevis94, and is inserted into the base of the distal phalanx 70 of the greattoe.

FIG. 7 is a medial view of tendons at the MTP joint 61 of the first ray.A medial collateral ligament 108 originates from the head of the firstmetatarsus 50 and inserts into the proximal phalanx 60. A medialmetatarsosesamoid ligament 110 originates from the head of the firstmetatarsus 50 and inserts into the medial sesamoid bone 96. Similarcollateral and metatarsosesamoid ligaments are found on the lateral sideof the first MTP joint. The flexor hallucis brevis 94 is shown insertinginto the sesamoids 96, 98. Ligamentous fibers extend further distally inthe form of a phalangealsesamoid ligament 112 from the sesamoids to theproximal phalanx 60.

FIG. 8 is a sectional view taken along line 8-8 of FIG. 7 showing themetatarsal head 50, the tendon of the extensor hallucis longus 80, themedial and lateral sesamoid bones 96, 98, the grooves 100, 102 in whichthe sesamoids articulate, the crista 104 separating the grooves, theflexor hallucis longus 106, the abductor hallucis 114, and the adductorhallucis 116.

FIG. 9 is a dorsal view showing the dorsal capsular structure 84 of theMTC joint 51 of the first ray including the insertion of the tibialisanterior tendon 82.

FIG. 10 is a medial view of the MTC joint 51 of the first ray showingthe medial capsular structure 118.

FIGS. 11-13 illustrate deformities of the first ray. In a dorsal view,as shown in FIG. 11, an intermetatarsal angle (IMA) 120 may be measuredbetween the longitudinal axes of the first and second metatarsal bones50, 52. The angle is considered abnormal when it is 9 degrees or greaterand the condition is known as metatarsus primus varus (MPV) deformity. Amild deformity is less than 12 degrees, a moderate deformity is 12-15degrees, and a severe deformity is greater than 15 degrees. Similarly, ahallux valgus angle (HVA) 122 may be measured between the longitudinalaxes of the first metatarsus 50 and the first proximal phalanx 60 at theMTP joint 61. The angle is considered abnormal when it is 15 degrees orgreater and the condition is known as a hallux valgus (HV) deformity. Amild deformity is less than 20 degrees, a moderate deformity is 20 to 40degrees, and a severe deformity is greater than 40 degrees.

MPV and HV often occur together as shown in FIGS. 11-12. As thedeformities progress several changes may occur in and around the MTC andMTP joints. Referring to FIG. 13, as the IMA and HVA increase, theextensors 80, flexors 106, abductors 114, and adductors 116 of the firstray (along with the sesamoids 96, 98) are shifted laterally relative tothe MTP joint. The laterally shifted tendons exert tension lateral tothe MTP joint creating a bow string effect (as best seen in FIGS. 11 and12) that tends to cause the deformities to increase. The lateral shiftof the sesamoids 96, 98 is often accompanied by erosion of the crista.The abnormal muscle forces cause the metatarsus 50 to pronate, or inother words, rotate so that the dorsal example of the bone movesmedially and the plantar example moves laterally. Rotation in theopposite direction is referred to as supination. Soft tissues on themedial side of the MTP joint and lateral side of the MTC jointattenuate, through lengthening and thinning, thus weakening the capsuleand permitting the deformities to progress. Soft tissues on the oppositesides of the capsule tend to shorten, thicken and form contracturesmaking it difficult to reduce the joints to their normal angularalignment.

More generally, deformities of the first ray may include metatarsusprimus varus, hallux valgus, abnormal pronation, abnormal supination,abnormal dorsiflexion, and/or abnormal plantarflexion. These deformitiescorrespond to three different planar rotations. Metatarsus primus varusand hallux valgus result from rotations in the transverse plane 24.Pronation and supination are rotation in the coronal plane 10.Dorsiflexion and plantar flexion are rotation in the sagittal plane.

The terms “suture” and “suture strand” are used herein to mean anystrand or flexible member, natural or synthetic, able to be passedthrough material and useful in a surgical procedure. The term“transverse” is used herein to mean crossing as in non-parallel.

The present invention provides methods and devices for performing anosteotomy on a bone. FIGS. 14-17 depict an illustrative osteotomy guide200 according to the present invention. The guide 200 includes a guidebody 202 having a proximal end 204, a distal end 206, a first side 208,a second side 210 opposite the first side 208, an upper surface 4, and alower surface 211. First and second guide surfaces 212, 214 are formedon the first side 208 of the guide body and are separated by a guideangle 217. The first and second guide surfaces 212, 214 converge fromthe first side 208 toward the second side 210 of the guide body anddefine a wedge shaped slot 215. The first and second guide surfaces areoperable to guide a cutter to remove a wedge of bone from a first sideof a bone. The open wedge shaped slot 215 shown in the illustrativeexample of FIGS. 14-17 facilitates visualization of the bone to be cutand removal of the cut bone. A third guide surface 216 is formed on thesecond side 210 of the guide body. The third guide surface 216 isoperable to guide a cutter to make a cut on a second side of a bone. Forexample, in the illustrative example of FIGS. 14-17, the first, second,and third guide surfaces 212, 214, 216 include planar surfaces againstwhich a cutter may be supported to guide the cutter to make a cutcoplanar with the guide surface. In the illustrative example of FIGS.14-17, an optional fourth guide surface 218 is provided parallel to andopposite the third guide surface 216 to further constrain a cutter. Thethird and fourth guide surfaces 216, 218 define a parallel slot 220between them operable to constrain a saw blade between them to a singleplane. The third and fourth guide surfaces 216, 218 are spaced apart sothat slot 220 receives a cutter, e.g. a saw blade, in planar slidingrelationship. Similarly, rather than forming an open wedge, the firstand second guide surfaces 212, 214 may be opposed by fifth and sixthguide surfaces to define narrow slots separated by the guide angle 217and able to receive a cutter in planar sliding relationship. The guidesurfaces 212, 214, 216 converge toward the center of the guide 200 butare spaced apart at the center by a solid portion 238. The solid portion238 of the guide acts as a cutter stop to prevent a cutter from cuttingall the way through the bone so that a central portion of the bone ispreserved to act as a hinge about which the bone may be rotated.

The guide body 202 includes one or more fixation elements for attachingthe guide to a bone to be cut. In the illustrative example of FIGS.14-17, a plurality of fixation elements are provided with at least onefixation element proximal to the guide surfaces and at least onefixation element distal to the guide surfaces. In the illustrativeexample of FIGS. 14-17, the fixation elements are in the form of holes222, 224, 226, 228 through the guide body 202 from the upper surface 209to the lower surface 211 and operable to receive pins, nails, screws orother suitable fasteners to attach the guide body 202 to a bone. In theillustrative example of FIGS. 14-17, three holes 222, 224, 226 areprovided proximal to the guide surfaces 212, 214, 216 and one hole 228is provided distal to the guide surfaces.

The lower surface 211 of the guide body 202 is curved to form a concaveprofile 230 to engage a curved outer surface of a bone. In theillustrative example of FIGS. 14-17, the third guide surface 216 iscoplanar with the second guide surface 214 to aid in producing a bonewedge that will better fit the opposite side of the bone as will beexplained in more detail below. The guide surfaces 212,214, 216 guide acutter to make cuts that converge toward the center of the guide 200from each of the first and second sides 208, 210 but stop short ofmeeting and completely bisecting the bone. This leaves a portion of boneintact toward the center of the bone.

A reference mark 232 is provided to indicate the amount of angularcorrection that the guide 200 will produce. The reference mark 232 isangled relative to a first, longitudinal axis 234 of the guide by thesame amount as the first guide surface 212 is angled relative to asecond axis 236 perpendicular to the first axis 234. In the illustrativeexample of FIGS. 14-17, the first axis 234 extends proximodistally andthe fixation holes 222, 224, 226, and 228 are aligned on the first axis234. The second axis 236 is perpendicular to the first axis 234 andextends between the first and second sides 208, 210.

The osteotomy guide 200 may include a set of two or more osteotomyguides, each of which has a different guide angle 217. The osteotomyguide 200 may include guides with mirrored guide surface positions. Forexample, on one osteotomy guide, the first and second guide surfaces212, 214 may form a wedge on the first side 208 of the guide (as shown)while on another guide, the first and second guide surface may form awedge on the second side 210 of the guide. For example, a right guidemay be provided for cutting a bone on the right side of a patient's bodyand a mirrored left guide may be provided for cutting a bone on the leftside of a patient's body. For example, an osteotomy guide for guidingthe formation of an osteotomy for correcting an MPV deformity of thefirst ray of a human foot may be provided in a right configuration withthe wedge producing first and second guide surfaces 212, 214 on thefirst side 208 of the guide corresponding to the lateral side of a rightfoot metatarsus and a left configuration with the wedge producing firstand second guide surfaces 212, 214 on the second side 210 of the guidecorresponding to the lateral side of a left foot metatarsus.Alternatively, the guide may have sufficient symmetry to allow it to berotated 180 degrees for use on a left or right bone.

FIGS. 18-22 illustrate a method of performing an osteotomy on a bone.While the osteotomy guide of FIGS. 14-17 is well suited to performingthe illustrative osteotomy, the osteotomy may be performed using anotherguide or no guide at all with the cuts being made freehand. However, theillustrative method will be described being performed with theillustrative guide of FIGS. 14-17 along with advantages that result fromusing such a guide.

In an illustrative method according to the present invention, a portionof bone is removed from a first side of a bone to create a gap on thefirst side of the bone. A cut is made on a second side of the bone,opposite the first side. The bone is rotated from a first, initialposition in which the bone was cut to a second position to close the gapon the first side of the bone and open the cut on the second side of thebone to create a gap on the second side of the bone. The bone may be cutthrough such that the cuts on opposite sides of the bone meet.Alternatively, the cuts may stop short of meeting so that a portion ofbone remains connecting the proximal and distal bone portions and aboutwhich the bone may rotate or bend. The bone may be fixed in the secondposition to heal. The gap on the second side of the bone may be filledto facilitate bone healing.

For example, the gap may be filled with a filler including autografttissue, allograft tissue, xenograft tissue, plastic, metal, or ceramic.The portion of bone removed from the first side of the bone may be usedto fill the gap created on the second side of the bone to facilitatebone healing. For example, a wedge of bone may be removed from the firstside of the bone and inserted into a wedge shaped gap formed on thesecond side of the bone when the bone is rotated.

The bone may be secured in the second position with a fixation elementsuch as, for example, a plate, pin, screw, or other fixation element.

In the illustrative method of FIGS. 18-22, an osteotomy guide 200 ispositioned over a bone to be cut. In the illustrative method of FIGS.18-22, the bone is a first metatarsus 300 of a human foot having an MPVangular deformity. The osteotomy guide 200 is selected to have a guideangle 217 corresponding to a desired amount of MPV angular correctionand a configuration appropriate for the operative side of the body. Inthe illustrative example of FIGS. 18-22, the deformity is on a rightfoot so it is desirable to move the distal end of the metatarsus 300laterally. Therefore, a guide 200 is selected with the wedge producingfirst and second guide surfaces 212, 214 on the first or lateral side208 of the guide. One or more pins, screw, nails, or other fixationmembers are inserted through the osteotomy guide 200 and into the boneto secure the osteotomy guide 200 to the bone. In the illustrativeexample of FIGS. 18-22, two pins 302, 304 are inserted through two holes224, 226 in the proximal portion of the osteotomy guide 200 proximal tothe guide surfaces. The pins secure the osteotomy guide 200 to themetatarsus 300. Utilizing two pins and two holes advantageouslyconstrains the osteotomy guide 200 rotationally relative to themetatarsus 300. An additional pin may be placed in hole 222 to attachthe osteotomy guide 200 to the first cuneiform bone 306.

Referring to FIG. 19, a cutter is guided by first and second guidesurfaces 212, 214 to remove a wedge 308 of bone from the lateral side ofthe metatarsus 300 leaving a lateral gap 309 and to make a cut 310 onthe medial side of the metatarsus.

The central solid portion 238 of the guide prevents the cuts from themedial and lateral sides from meeting so that a portion of bone 312 ispreserved as seen in FIG. 20. The distal portion of the metatarsus isrotated about the portion of bone 312 to close the lateral gap 309 andopen the cut 310 on the medial side creating a medial gap 311. The wedge308 from the lateral side is inserted into the medial gap 311. The boneis supported for healing with a plate 314 and screws 316. Optionally, afixation member may be placed through the distal fixation hole 228 inthe guide after the bone is rotated to support the bone in the rotatedposition to facilitate grafting the medial gap and placing the plate 314and screws 316. The completed correction is shown in FIGS. 21 and 22.

FIGS. 23-27 depict another example of an illustrative osteotomy guide400 configured generally like that of FIG. 14. The guide 400 includes aguide body 402 having a proximal end 404, a distal end 406, a first side408, a second side 410 opposite the first side 408, an upper surface409, and a lower surface 411. First and second guide surfaces 412, 414are formed on the first side 408 of the guide body and are separated bya guide angle 417. The first and second guide surfaces 412, 414 convergefrom the first side 408 toward the second side 410 of the guide body anddefine a wedge shaped slot 415. A third guide surface 416 is formed onthe second side 410 of the guide body. In the illustrative example ofFIGS. 23-27, an optional fourth guide surface 418 is provided parallelto and opposite the third guide surface 416. The third and fourth guidesurfaces 416, 418 define a parallel slot 420 between them operable toconstrain a saw blade between them. The guide surfaces 412, 414, 416converge toward the center of the guide 400 but are spaced apart at thecenter by a solid portion 438.

The guide body 402 includes one or more fixation elements for attachingthe guide to a bone to be cut. In the illustrative example of FIGS.23-27, a plurality of fixation elements is provided in the form of holes422, 424, 426, 428 through the guide body 402 from the upper surface 409to the lower surface 411 and operable to receive pins, nails, screws orother suitable fasteners to attach the guide body 402 to a bone.

The lower surface 411 of the guide body 402 is curved to form a concaveprofile 430 to engage a curved outer surface of a bone.

In the illustrative example of FIGS. 23-27, first and second walls 450,452 are provided on the first and second sides 408, 410. The first wall450 caps the end of the wedge shaped slot 415 and the second wall 452caps the end of the parallel slot 420. The first and second walls 450,452 project above the upper surface 409 to terminal ends 454, 456. A sawblade guided by the one of the guide surfaces 412, 414, 416, 418defining the slots 415, 420 is constrained to limited angles byimpinging on the guide surfaces, the solid portion 438, the walls 450,452 and terminal ends 454, 456. By adjusting the width and height ofthese features and the width and length of the saw blade, it is possibleto protect structures surrounding the bone from being cut fromaccidental contact with the saw blade.

Reference marks 432, 434 are provided to indicate the amount of angularcorrection that the guide 400 will produce. A correction reference mark432 is angled relative to an axial reference mark 434 by the same amountas the first guide surface 412 is angled relative to a second axis 436perpendicular to the axial reference mark 434. The reference marks givean immediate visual indication of the amount and direction of angularcorrection. The correction reference mark 432 is preferably labeled“Correction” for clarity. Additional text indicators may be providedsuch as a direction indicator 460 and a magnitude indicator 462. Forexample, in the illustrative example of FIGS. 23-27, the directionindicator 460 contains the text “Left” or “Right” to indicate thedirection of the correction or the side of the patient's body on whichit is to be used. The magnitude indicator 462 contains text indicatingthe number of degrees of angular correction that the guide 400 provides.In the illustrative example of FIGS. 23-27, the guide further includes alabel adjacent the proximal end 404 indicating where to position theproximal end. For example, in the illustrative example of FIGS. 23-27,the proximal end is labeled “Joint Line” to indicate that for ametatarsal corrective osteotomy, the proximal end should be positionedat the joint line of the MTC joint. In the illustrative example of FIGS.23-27, the fixation holes 422, 424, 426, 428 are positioned to receivepins into the metatarsus with two proximal to the osteotomy cuts and twodistal to the osteotomy cuts.

Referring to FIG. 28, a set 500 of osteotomy guides 504, 506, 508, 510,512, 514 are provided in a tray 502. In the illustrative example of FIG.28, three “Left” guides 504, 508, 512 and three “Right” guides 506, 510,514 are provided. The left guides are provided in three correctiveangles corresponding to 5, 10, and 15 degrees of angular correction. Theright guides are also provided with 5, 10, and 15 degrees of angularcorrection.

Various examples have been provided to illustrate the present invention.It will be understood that variations may be made and still be withinthe scope of the invention.

1. (canceled)
 2. An osteotomy guide comprising: a body having a proximalend and a distal end; a first guide surface operable to guide a cutterto make a first cut; a second guide surface operable to guide a cutterto make a second cut, the second guide surface disposed at a guide anglerelative to the first guide surface; at least one proximal fixation holeproximal to the guide surfaces and aligned along an axis of theosteotomy guide; and at least one distal fixation hole distal to theguide surfaces, the at least one distal fixation hole aligned with theat least one proximal fixation hole along the axis of the osteotomyguide.
 3. The osteotomy guide of claim 2, wherein the first guidesurface defines a plane perpendicular to the axis of the osteotomyguide.
 4. The osteotomy guide of claim 2, wherein the guide angle is atleast 5 degrees.
 5. The osteotomy guide of claim 4, wherein the guideangle is at least 10 degrees.
 6. The osteotomy guide of claim 2, furthercomprising a wall extending perpendicularly from a first side of thebody between the proximal end and the distal end.
 7. The osteotomy guideof claim 6, wherein the at least one wall extends from the first side ofthe body at a location proximate at least one of the first and secondguide surfaces.
 8. The osteotomy guide of claim 2, wherein the at leastone distal fixation hole includes two distal fixation holes alignedalong the axis of the osteotomy guide.
 9. The osteotomy guide of claim2, further comprising a third guide surface operable to guide a cutterto make a third cut.
 10. The osteotomy guide of claim 9, wherein thethird guide surface is parallel to the first guide surface.
 11. Theosteotomy guide of claim 9, wherein the third guide surface isconfigured to guide the cutter such that the third cut is coplanar withthe first cut.
 12. The osteotomy guide of claim 2, further comprising analignment feature configured to guide positioning of the osteotomy guiderelative to a joint.
 13. The osteotomy guide of claim 12, wherein thejoint is a metatarso cuneiform (MTC) joint of a foot.
 14. The osteotomyguide of claim 2, wherein the osteotomy guide is configured for cuttingone or more bones of a first ray of a foot.
 15. The osteotomy guide ofclaim 2, wherein the osteotomy guide is configured for correction ofhallux valgus.
 16. The osteotomy guide of claim 15, wherein the guideangle corresponds to an amount of angular correction of a first ray of afoot.
 17. The osteotomy guide of claim 2, wherein the osteotomy guide iseither a left guide configured for bone cutting of a left foot of apatient or a right guide configured for bone cutting of a right foot ofa patient.
 18. The osteotomy guide of claim 2, wherein the osteotomyguide is a universal guide having sufficient symmetry to be operable forbone cutting of either a left foot or a right foot of a patient.
 19. Theosteotomy guide of claim 18, wherein the osteotomy guide is operable forbone cutting of a left foot in a left configuration rotated 180 degreesrelative to a right configuration in which the osteotomy guide isoperable for bone cutting of a right foot.